MEDICARE: MR. BRUCE FREIFELD MS,PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor	020586-1	NY

General Provider Information

NPI Number	:	1467606988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE FREIFELD MS,PT

Provider Business Mailing Address
First Line	:	5635 NETHERLAND AVE
Second Line	:	APT. 4B
City	:	BRONX
State	:	NY
Zip	:	10471-1739
Country	:	US
Telephone Number	:	718-796-6588
Fax Number	:

Provider Business Practice Location Address
First Line	:	5635 NETHERLAND AVE
Second Line	:	APT. 4B
City	:	BRONX
State	:	NY
Zip	:	10471-1739
Country	:	US
Telephone Number	:	718-796-6588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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